Topic: Pediatric Conditions Affecting the Eyes, Mouth, and Gastrointestinal System
This week you are covering several areas, including pediatric management of eyes, oral disorders, and gastrointestinal conditions.
You will be discussing pathophysiology, epidemiology, clinical findings, diagnostics, differential diagnoses, and management plans of disorders related to the above.
Focusing on the pediatric patient, select one of the topics below and discuss the current evidence-based recommendations by leading pediatric experts and professional organizations. Focus your discussion on guidelines for pediatric healthcare providers prescribing medications to the young pediatric patient.
You are expected to present your initial topic, including, but not limited to, the following items:
Pathophysiology
Physical exam findings
Differential diagnoses and rationale
Management plan to focus on pharmacotherapy agents based upon evidence-based practice guidelines
Topics:
Conjunctivitis (all types) and nystagmus
Amblyopia and strabismus
Retinopathy of prematurity
Dental caries, candidiasis, aphthous ulcers
Retinoblastoma
Gastroesophageal reflux disease in pediatrics
Peptic ulcer disease in pediatrics
Appendicitis and functional abdominal pain syndrome
Intussusception and pyloric stenosis
Malabsorption syndromes: celiac disease, lactose intolerance, cow’s milk protein intolerance, or allergy
Failure to thrive
Acute gastroenteritis and intestinal parasites
Constipation and encopresis
Periorbital cellulitis and orbital cellulitis
Glaucoma and cataracts in pediatrics
Corneal ulcers and hordeolum
Cyclic vomiting syndrome
You will start with retinoblastoma, which is a malignant tumor that arises from the retina in one or both eyes. The cause is often hereditary but can also result from genetic mutation and is the most common malignant tumor in children. The incidence is roughly 1 in 12,000–18,000 live births, with a higher incidence seen in Alaskan Eskimos and Native Americans (Burns et al., 2013). As with any other malignant tumor, retinoblastomas can spread and become metastatic. In underdeveloped countries, delayed diagnosis can lead to death, often from a brain tumor (Burns et al., 2013).
Physical findings are most commonly strabismus, opaque pupil, absent red reflex, and vision loss to some degree. A CT scan with contrast or MRI should be done for any suspicion. Further diagnostics would be performed by an ophthalmologist and may include needle aspiration, fundus photography, or ocular ultrasound.
Differentials include anything with loss of vision acuity, such as glaucoma, injury, cataracts, uveitis, or retinal detachment.
Early diagnosis is always the goal, and regular vision screenings and eye examinations are the standard of care for all children beginning at birth (Chiocca, 2015). Management is an urgent referral to a pediatric ophthalmologist. The NP may see these children in primary care and should monitor closely for possible progression or complications such as intraocular/extraocular tumors. Immediate family members require fundi examinations.
Prognosis depends on the size and involvement of the tumor. There is an increased risk of developing a second malignancy.
Family education is essential. These children need close follow-up (at least every 3 months) by the ophthalmologist for at least 2 years.
